Republican Georgia Gov. Brian Kemp is requesting a partial Medicaid expansion waiver from CMS. Kemp, who campaigned against a full Medicaid expansion, said he wants to explore a smaller option. Democrats in the state have decried spending money on a waiver proposal rather than going through with full expansion.
Meanwhile, in Utah, Republican legislators approved a more limited version of Medicaid expansion than approved by voters in the fall. Utah Gov. Gary Herbert said the voter-approved expansion plan would result in "real problems when it comes to sustainability and affordability for the state."
- Democratic leaders in Republican-leaning states, such as Tennessee and Wyoming, are eyeing expansion. In Montana, the state's hospital association agreed to fund Medicaid expansion partially. Montana voters had turned down a ballot initiative that would have increased tobacco taxes to pay for Medicaid expansion.
Under the Affordable Care Act, states can expand Medicaid to cover people below 138% of the federal poverty level, and 12 million people have gained coverage this way. Studies credit Medicaid expansion with improving people's health, lowering maternal mortality rates, reducing barriers to care and helping hospitals' finances.
Newly minted House Speaker Nancy Pelosi recently said Democrats hope to push the 14 non-Medicaid expansion states to open the programs and Congress may give states more money to expand. However, some Republicans in Washington back a partial Medicaid expansion for non-expansion states.
The politics of Medicaid expansion has shifted in recent years. While most red states opposed it in the early years, the midterms saw several Republican states change their tune. Idaho, Utah and Nebraska have approved expansion plans recently. Virginia also implemented expansion this year.
Still, the Trump administration's CMS has encouraged hurdles to getting aid, clearing work requirement waivers to eight states. Democrats and critics say the work rules don't work and hurt the most vulnerable.
Michigan Gov. Gretchen Whitmer said she plans to make changes to Michigan's Medicaid work requirements before they go into effect. The Democratic governor is concerned about people losing coverage. Whitmer pointed to a recent study showing that up to 183,000 Michigan residents could lose Medicaid with a work requirement.
Other challenges remain for expansion. Despite the millions of newly insured, many doctors are still cool to the program. Physicians are less likely to take Medicaid than either Medicare or private insurance, citing Medicaid's lower reimbursement level. A recent report suggested that more doctors would take Medicaid if states improved reimbursement for the program.